Assisting Patient with Oral Care

Adequate oral hygiene care is imperative to promote the patient’s sense of well-being and prevent deterioration of the oral cavity. Poor oral hygiene is reported to lead to the colonization of the oropharyngeal secretions by respiratory pathogens. Diligent oral hygiene care can improve oral health and limit the growth of pathogens in the oropharyngeal secretions, decreasing the incidence of aspiration pneumonia and other systemic diseases (Yoon & Steele, 2007; American Association of Critical-Care Nurses [AACN], 2006). The mouth requires care even during illness, but sometimes care must be modified to meet a patient’s needs. If the patient can assist with mouth care, provide the necessary materials. Oral care is important not only to prevent dental caries but also to improve the patient’s self-image. Oral care should be done at least twice a day for ambulatory patients.

 Equipment

• Toothbrush
• Toothpaste
• Emesis basin
• Glass with cool water
• Disposable gloves
• Additional PPE, as indicated
• Towel
• Mouthwash (optional)
• Washcloth or paper towel
• Lip lubricant (optional)
• Dental floss

Assessment

Assess the patient’s oral hygiene preferences: frequency, time of day, and type of hygiene products. Assess for any physical activity limitations. Assess patient’s oral cavity and dentition. Look for any inflammation or bleeding of the gums. Look for ulcers, lesions, and yellow or white patches. The yellow or white patches may indicate a fungal infection called thrush. Assess for signs of dehydration (dry mucosa) and dental decay. Look at the lips for dryness or cracking. Ask the patient if he or she is having pain, dryness, soreness, or difficulty chewing or swallowing. Assess patient’s ability to perform own care.

Nursing Diagnosis

Determine the related factors for the nursing diagnosis based on the patient’s current status. Possible nursing diagnoses may include:

• Risk for Aspiration          
• Disturbed Body Image
• Ineffective Health Maintenance  
• Deficient Knowledge
• Impaired Oral Mucous Membrane

Outcome Identification and Planning

The expected outcome is that the patient’s mouth and teeth will be clean; the patient will exhibit a positive body image; and the patient will verbalize the importance of oral care. 

Implementation

1. Perform hand hygiene and put on glove if assisting with oral care, and/or other PPE, if indicated.
2. Identify the patient. Explain procedure to the patient.
3. Assemble equipment on overbed table within patient’s reach.
4. Close the room door or curtains. Place the bed at an appropriate and comfortable working height; usually elbow height of the caregiver (VISN 8 Patient Safety Center, 2009).
5. Lower side rail and assist patient to sitting position, if permitted, or turn patient onto side. Place towel across patient’s chest. Raise bed to a comfortable working position.
6. Encourage patient to brush own teeth, or assist, if necessary.

a)      Moisten toothbrush and apply toothpaste to bristles.

b)     Place brush at a 45-degree angle to gum line and brush from gum line to crown of each tooth. Brush outer and inner surfaces. Brush back and forth across biting surface of each tooth.

c)      Brush tongue gently with toothbrush.

d)     Have patient rinse vigorously with water and spit into emesis basin. Repeat until clear. Suction may be used as an alternative for removal of floss and secretions from mouth. 

      7. Assist patient to floss teeth, if appropriate:

a)      Remove approximately 6 inches of dental floss from container or use a plastic floss holder. Wrap the floss around the index fingers, keeping about 1 to 1.5 inches of floss taut between the fingers.

b)      Insert floss gently between teeth, moving it back and forth downward to the gums.

c)      Move the floss up and down, first on one side of a tooth and then on the side of the other tooth, until the surfaces are clean. Repeat in the spaces between all teeth.

d)     Instruct patient to rinse mouth well with water after flossing.

      8. Offer mouthwash if patient prefers. 

      9. Offer lip balm or petroleum jelly. 

     10. Remove equipment. Remove gloves and discard. Raise side rail and lower bed. Assist patient  to a position of comfort. 

     11. Remove any other PPE, if used. Perform hand hygiene.

 

Evaluation
The expected outcomes are met when the patient receives oral care, experiences little to no discomfort, states mouth feels refreshed, and demonstrates understanding of reasons for proper oral care.

Documentation

Record oral assessment, significant observations and unusual findings, such as bleeding or inflammation. Document any teaching done. Document procedure and patient response.

Sample documentation: 31/03/18 @0930 Patient performed oral care with minimal assistance. Oral cavity mucosa pink and moist. No evidence of bleeding or ulceration. Lips slightly dry; lip moisturizer applied. Reinforcement provided related to importance of flossing teeth every day. Patient demonstrates appropriate flossing technique.

___HSN,RN

 Source: Lynn, P., & Taylor, C. (2011). Taylors clinical nursing skills: A nursing process approach. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.